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An increasing number of parents may be choosing to delay or limit certain vaccinations for their young children, a new study shows, even as cases of pertussis, or whooping cough, continue to rise nationwide, with recent outbreaks in California and Washington.

The study, which examined medical records for 97,711 Portland children, found an almost four-fold increase between 2006 and 2009 in the percentage of parents who delayed or skipped vaccinations, researchers reported in the journal Pediatrics. Experts say that by delaying certain vaccinations, parents may be putting their children — and those of others — at a far greater risk of contracting deadly diseases, such as pneumonia and pertussis.

The new study examined the vaccination histories of children born in the Portland area between 2003 and 2009. Between 2006 and 2009, the number of parents who rejected government recommendations and made up their own vaccine schedules rose from 2.5 percent to 9.5 percent.

While the researchers could not say how typical the Portland results are compared to other areas around the country — Portland schools reportedly have some of the highest vaccine exemption rates in the U.S. — a 2011 study published in Pediatrics found that 13 percent of parents nationwide were using alternative schedules. Another study published in Public Health Report in 2010 found that almost 22 percent of parents were deviating in some way from the CDC’s recommendations for infant vaccinations – either by delaying shots, leaving out certain vaccines, or skipping vaccinations altogether.

The vaccine delays may not completely explain recent whooping cough outbreaks in states such as California and Washington, but “they certainly don’t help,” said Dr. Jaime Deville, a UCLA professor of infectious diseases in the pediatrics department.

The main reason parents give for delaying shots is fear their children will be harmed by receiving multiple vaccines at the same time, according to the study’s lead author, Steve Robison, an epidemiologist at the Oregon Health Authority. The vaccines most likely to be delayed by 9 months were for hepatitis B and pneumococcal disease (pneumonia).

For example, at both the two- and six-month visits the CDC recommends kids get a total of six vaccines. Even with some of them combined that adds up to a lot of shots. By age 4, children receive up to 28 vaccinations, based on the CDC immunization schedule.

Some parents believe they’ll get the same benefit if they spread the vaccinations out over more doctors’ visits rather than getting them all at once.

“There are rumors out there that your body can’t handle that many vaccines, that your body won’t be able to respond appropriately if you get several all at one time,” Robison said.

Experts say vaccines pose no harm to babies; even though multiple shots can be painful for a few moments, they say the consequences of delaying vaccinations can be much worse.

There are reasons for concern over the delayed vaccines. According to the Centers for Disease Control and Prevention there were 2,325 cases of pertussis in Washington state through June 9, 2012, compared to 171 during the same time period in 2011. A 2010 outbreak in California led to 9,143 cases — including 10 infant deaths — the most cases in that state since 1947.

“We’d like parents to know that the recommended number of doses of a vaccine is what is needed to build adequate protection levels both for their child and for the community,” Robison said. “One dose of a vaccine, such as for pertussis, doesn’t build enough protection.”

By 9 months, infants on an alternative vaccine schedule had fewer injections than those with parents following the government recommended schedule — an average of 6.4 versus 10.4 shots — and more doctors’ visits for vaccinations.

What’s more, few had caught up with the recommended number of vaccinations by the end of the study.

One big problem with the modified schedule is that parents are bringing children who haven’t been appropriately vaccinated into the doctor’s office more often — thus putting other kids at greater risk, said pediatrician Dr. Andrew Nowalk, an assistant professor at the Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center.

Deville is especially concerned about parents who are choosing to delay the pneumococcal vaccine until age 2. Infants are most vulnerable to pneumonia during the first year of life. “Parents who delay the vaccine until age 2 are leaving their children vulnerable during the period where it occurs at its highest frequency,” Deville said.

An added advantage of the pneumococcal vaccine is that it lowers the amount of bacteria living in kids’ noses and throats, Nowalk said. “So the children who aren’t getting vaccinated are more likely to be carrying the bacteria without being infected and spreading it to others,” he added. “When you don’t vaccinate your child you’re not only putting your child at risk but also those of others.”

Further, Nowalk said, there are lots of kids out there with immune deficiencies — those with leukemia, or depressed immune systems because of organ transplants, for example — who can’t get vaccines. So they have to rely on everyone else getting vaccinated.

“When enough of the population is immunized, transmission is essentially stopped,” Deville explained. “The bottom line is that immunizations are extremely safe. They have the most value of any of our interventions when it comes to prolonging life and preventing diseases – not only for our own children but also for the community.”

While these cases are certainly extreme, experts say that any punishment that shames or embarrasses a child is not an effective way to discipline youngsters, and may cause long-term psychological damage.

“The research is pretty clear that it’s never appropriate to shame a child, or to make a child feel degraded or diminished,” said Andy Grogan-Kaylor, an associate professor of social work at the University of Michigan. Such punishments can lead to “all kinds of problems in the future,” Grogan-Kaylor said, including increased anxiety, depression and aggression.

Malicious punishments can also damage a parent’s relationship with their child, and lead to a cycle of bad behavior, experts say.

Instead, parents should use other discipline strategies, such as setting clear rules for kids and taking away privileges. Overall, parents should aim to create a supporting environment for their child.

“Positive things have a much more powerful effect on shaping behavior than any punishment,” Grogan-Kaylor said.

Damaging punishments

Out-of-the norm punishments can have social repercussions for children, said Jennifer Lansford, a research professor at Duke Univesity’s Center for Child and Family Policy. An odd punishment can make a child stand out, and provoke bullying, Lansford said.

In addition, children evaluate their own experiences in the context of what they see their peers experiencing, Lansford said. If children are disciplined in ways that are not condoned by society, “it can lead children to perceive they are personally rejected by their parents,” Lansford said.

Humiliating punishments can also disconnect parents from their children, making kids less likely to want to behave and do what their parents say, said Katharine Kersey, a professor of early childhood education at Old Dominion University in Norfolk, Va., and author of the upcoming book “101 Principles for Positive Guidance with Young Children” (Allyn & Bacon, August 2012).

“Each time we [embarrass children with a punishment] we pay a price, and we drive them away from us, and we lose our ability to be a role model for them,” Kersey said.

“When you disconnect from a child, he no longer wants to please you, he no longer wants to be like you. You’ve lost your power of influence over him,” Kersey said.

Children who are punished in these ways usually still commit the behavior, but do it behind their parents’ backs, Kersey said.

Better ways to discipline

To properly discipline a child, experts recommend the following:

Focus on the positive — the behaviors you want to see more of — rather than the mistakes, Kersey said. “If a child is running, instead of saying stop running, you say use your walking feet,” Kersey said.

Be proactive: establish rules you want your kids to follow, and be reasonable in your expectations, Lansford said.

Listen to your kids: Often times, bad behavior is a mistake, Grogan-Kaylor said. Parents should listen to why their children did something, and explain why the behavior is inappropriate.

Timeouts are appropriate for younger kids. For older kids, taking away privileges such as watching TV may be effective, Lansford said. In a classroom setting, teachers may consider rewarding kids for good behavior, Lansford said.

Parent should model the responsible behaviors they want children to repeat, Kersey said.

Pass it on: Humiliating punishments don’t work to discipline children, and may have long-term consequences.

A big job that parents have to deal with, learn about, and work to prevent is eating disorders. In the United States as many as 10 million females and 1 million males are affected with an eating disorder. About 40% of eating disorder sufferers are between the ages of fifteen to twenty-one years old. Every decade since 1930, there has been a rise in anorexia. From 1988 to 1993 bulimia has tripled in women ages ten to thirty-nine. The mortality rate among women, who suffer from anorexia nervosa between the ages of fifteen to twenty four, is twelve times higher than the death rate of any other cause.

These are some scary statistics and everyday they are affecting young women and men. This article is to help educate about what eating disorders are, how to recognize the signs and symptoms of an eating disorder, and most of all how prevent eating disorders. Children are very influential, they pick up on everything. They see and hear everything we do and say. Next time you are looking in the mirror saying “I’m so fat” remind yourself that those little eyes and ears are watching you and learning from you.

What is an eating disorder? According to the National Eating Disorder Association, “An eating disorder is a serious, but treatable illness with medical and psychiatric aspects. People with an eating disorder often become obsessed with food, body image, and weight. The disorders can become very serious, chronic, and sometimes even life threatening if not recognized and treated appropriately. Treatment requires a multidisciplinary approach with an experienced care team.”

Who is at risk for getting an eating disorder? In today’s society almost anyone is at risk now for developing an eating disorder. The previous stereotype that eating disorders only affect Caucasian, teenage girls who are perfectionist, people pleasers and from an upper class socioeconomic group, no longer holds true. Eating disorders are affecting children as young as 7 or 8 years old men and women well into their 30’s and 40’s. We are seeing a rise in eating disorders among men and young boys and eating disorders are affecting people in every socioeconomic and ethnic group.

What are the signs and symptoms of an eating disorder? Here are a few red flags that you child may be at risk for developing an eating disorder.

Is your child avoiding certain food groups because they are “fattening”? If your child suddenly proclaims he or she is now a vegetarian this could be a red flag for an eating disorder. For many eating disorder sufferers, especially young children and teenagers, proclaiming vegetarianism suddenly makes it okay and acceptable by family and peers to avoid whole food groups such as meat, eggs, fish, and dairy.

When in a social situation and around food does your child act differently? Either by shrinking away and refusing to eat anything or by losing sense of control and overeating?

Do you hear your young one constantly talking about weight loss, body size, and food? Always seeking reassurance from others about looks and referring to self as fat, gross, or ugly? Overestimating body size? Striving to create a “perfect” image? These are not healthy behaviors for anyone, especially young children and teens.

Have you seen a sudden change in weight? Either dramatic weight loss or big fluctuations in weight over a short period of time?

If you notice some of these signs and symptoms with a loved one, seek out support now. Getting the right help and support can prevent serious issues from developing later on.

Can I really work at preventing eating disorders? Yes. Listed below are a few tips of simple things that can help build the confidence of your child and prevent eating disorders.

Change dinner table talk. For many young people, struggling with an eating disorders can stem from parents own obsession with dieting, weight loss, calorie control, exercise, and looks. Instead of talking about the latest diet or weight loss plan that you may be following, use your time together to discuss other topics. Ask your child questions about school and social events, take up a hobby together that does not focus on looks.

Seek professional support. If your child wants to lose weight or adapt a specific lifestyle such as being a vegetarian make sure he or she is doing it for the right reasons. Schedule an appointment with a professional such as a registered dietitian who can help educate and ensure adequate nutrient intake.

Avoid being the food police. If you know your child is trying to lose weight, avoid commenting on everything he or she puts on the plate or into their mouth. Constantly watching and monitoring food intake only sets the tone for resentment, overeating or under eating, shame, and guilt; all which can lead to a serious eating disorder.

Encourage activities that promote a positive body image. Involve your child in activities that make him or her feel good. If your child is in an environment where he or she is constantly being ridiculed or made fun of by a coach or team mates, change the environment. Find positive outlets for your child to thrive in.

Limit exposure to trendy TV shows and magazines. These media sources are constantly bombarding young minds with how they are supposed to look. Remind your child that these “famous” people have been airbrushed and touched up with every computer program available to give the “perfect” look.

Remember, from a very early age children pick up from what is going on with parents. If you are constantly on a diet, always talking about either your own body size or other people’s body size, your child is hearing you. The first step you can take in preventing an eating disorder is to treat yourself and others with love and respect and not always focus on the “image.” If you or a loved one is struggling with an eating disorder, seek out professional support. Using a multi-facet approach by working with a doctor, therapist and registered dietitian can help treat and overcome this scary disease.

The emotional and physical scars from being bullied or exposed to other types of violence as a child may go deeper than imagined.

New research shows that the genetic material, or DNA, of children who experienced violence shows the type of wear and tear that is normally associated with advancing age.

“Children who experience extreme violence at a young age have a biological age that is much older than other children,” says researcher Idan Shalev. He is a post-doctoral researcher in psychology and neuroscience at the Duke Institute for Genome Sciences & Policy in Durham, N.C.

Youth violence is widespread in the U.S. today. The CDC states that it’s the second leading cause of death among people between the ages of 10 and 24, and that nationwide, about 20% of students in grades 9-12 were bullied in 2009.

Bullied Kids Age Faster Than Others

To see whether youth violence affects vulnerability to aging, the study authors focused on telomeres, or tiny strips of genetic material that look like tails on the ends of our chromosomes; think of a cap on an end of a shoelace. Telomere shortening is an indicator of cell aging.

The researchers analyzed DNA samples from twins at ages 5 and 10 and compared telomere length to three kinds of violence: domestic violence between the mother and her partner, being bullied frequently, and physical maltreatment by an adult. Moms were also interviewed when kids were 5, 7, and 10 to create a cumulative record of exposure to violence.

Children who were exposed to cumulative violence showed accelerated telomere shortening from age 5 to age 10. What’s more, children who were exposed to multiple forms of violence had the fastest telomere shortening rate, the study shows.

“Children who experience violence appear to be aging at a faster rate,” Shalev says.

Whether or not these changes are reversible is not clear. Shalev and colleagues plan to study the children for longer periods of time to see what happens later on in life. Their findings appear in Molecular Psychiatry.

Bullying Scars Run Deep

Bullying and other violence experienced during childhood may cause a physical erosion of DNA, says Paul Thompson, PhD. He is a professor of neurology at the David Geffen School of Medicine at the University of California, Los Angeles.

“We now have a physical record that violence during childhood could be damaging later in life,” he says. This is a “big surprise.”

Victor Fornari, MD, director of child and adolescent psychiatry at the Zucker Hillside Hospital in Glen Oaks, N.Y., says the new findings make perfect sense. “This article really points to a potential biological [indicator] that helps explain some of the differences in the brains of children who have experienced significant trauma and stress,” he says.

For those of us who have parented children with learning disabilities, ADHD, and associated mental health issues, these figures not only represent challenges for our educational and health systems, they are deeply personal matters that affect the core of our families and our children’s happiness.

Beyond the logistics of educational assessments, tutoring, and daily homework challenges lies the responsibility of all adults—parents, teachers, and counselors—to foster a positive mindset that helps kids overcome the many obstacles they face.

Like millions of other students, my daughter’s story is unique. Among her many hurdles was learning to compensate for a reading speed in the lowest one percentile, a challenge that continues today as a 29-year-old.

But with acceptance and encouragement, children and young adults are surprisingly resilient and learn to embrace their differences. Recently, my daughter wrote about five ideas that fueled her success from middle school through law school as a student with learning disabilities and attention deficit disorder. She presented these ideas as part of an article, To Parents & Educators: From an Attorney with LD/ADHD and gave me permission to reprint them here.

Needless to say, I am very proud of how my daughter developed a path to accomplish goals she set for herself. But more importantly, what she outlines below as critical steps in her journey to understand and embrace her differences supports much of the research on positive youth development. All children must learn to overcome obstacles in order to believe in themselves!

In her own words, here are the five steps that were critical to my daughter’s success, ideas she now tries to instill in other young people.

Understand your Disabilities

Every student has strengths and weaknesses. But kids with diagnosed disabilities need to understand their academic and emotional assets and liabilities really well. By middle school, educational testing can help students look inside themselves and understand how their disabilities impact their studies and social lives. Knowing what they need from teachers, tutors, counselors, peers, and parents is a foundation for future growth.

Ask for Help

It’s okay to be different; embrace it. I can’t emphasize this enough. I have friends who were told to hide their disabilities from teachers. As a result, they felt unhappy and defeated. It wasn’t until they got tested, shared their disabilities, and requested accommodations that they were able to finally get into a college and get the degree they wanted. The earlier students learn to work with their disability and understand it as part of their identities the better. Embracing our disabilities give us the confidence to talk with teachers, administrators, and trusted friends about what we like, what we are good at, and what we need help with. We often can’t, and don’t have to do it alone.

Never Use your Disability as an Excuse

It can be easy to say to a teacher, “I need an extension on this paper because I am slow at writing.” While this may be okay early on in school, it doesn’t work in college or the real world. So why get used to it? Rather than using a disability as an excuse, students must find ways to compensate. Figure out how to work efficiently and effectively, rather than longer and harder. Most kids with learning disabilities need help developing efficient work habits. Ask for help!

Use Compensatory Strategies

Working longer hours is necessary at times. But it can also lead to burnout. There are lots of compensatory strategies for learning, and many books on the topic. You’ve likely heard of many, including, making lists, getting organized, using memory tricks, etc. The key is finding the strategies that work and altering others to make them your own.

For example, I’m a very slow reader and got frustrated when I couldn’t finish reading assignments. But I’m a good listener and I understand high-level concepts. My strategy was to listen in class, research the topic, and then boil down the minimum reading necessary. Finding strategies that worked for me helped me set limits on my school work, gave me time to socialize, and helped me have time for myself.

Taking time away from stressful school work is essential for students with learning disabilities and contributes to better mental health. It also allows students to focus on bigger dreams, careers that might take 4-8 years of secondary education!

Know you can Achieve your Goals

Setting goals is important for all of us. And most importantly, we have to develop the determination to achieve them! I encourage students with LD/ADHD to find adults who give them positive messages of encouragement, who listen to them when they express self-doubt. With the right support and strategies, we can do anything we set our minds to!

Having learning disabilities and/or ADHD is not easy. And it doesn’t end when we finish school. With every change, come new challenges and strategy adjustments. I always remember what the famous educator, Booker T. Washington said more than 100 years ago, “I have learned that success is to be measured not so much by the position that one has reached in life as by the obstacles overcome while trying to succeed.” Challenges are what make life exciting—they are what define who we are and who we become. Embrace the challenges!

A small but growing number of teens and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.

It’s an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones.

An 8-year-old second-grader in Los Angeles is a typical patient. Born a girl, the child announced at 18 months, “I a boy” and has stuck with that belief. The family was shocked but now refers to the child as a boy and is watching for the first signs of puberty to begin treatment, his mother told The Associated Press.

Pediatricians need to know these kids exist and deserve treatment, said Dr. Norman Spack, author of one of three reports published Monday and director of one of the nation’s first gender identity medical clinics, at Children’s Hospital Boston.

“If you open the doors, these are the kids who come. They’re out there. They’re in your practices,” Spack said in an interview.

JOSIE Romero looks and acts like any other eight-year-old girl – but was born a BOY named Joey.

Switching gender roles and occasionally pretending to be the opposite sex is common in young children. But these kids are different. They feel certain they were born with the wrong bodies.

Some are labeled with “gender identity disorder,” a psychiatric diagnosis. But Spack is among doctors who think that’s a misnomer. Emerging research suggests they may have brain differences more similar to the opposite sex.

Spack said by some estimates, 1 in 10,000 children have the condition.

Offering sex-changing treatment to kids younger than 18 raises ethical concerns, and their parents’ motives need to be closely examined, said Dr. Margaret Moon, a member of the American Academy of Pediatrics’ bioethics committee. She was not involved in any of the reports.

Some kids may get a psychiatric diagnosis when they are just hugely uncomfortable with narrowly defined gender roles; or some may be gay and are coerced into treatment by parents more comfortable with a sex change than having a homosexual child, said Moon, who teaches at the Johns Hopkins Berman Institute of Bioethics.

Doctors who provide the treatment say withholding it would be more harmful.

These children sometimes resort to self-mutilation to try to change their anatomy; the other two journal reports note that some face verbal and physical abuse and are prone to stress, depression and suicide attempts. Spack said those problems typically disappear in kids who’ve had treatment and are allowed to live as the opposite sex.

Guidelines from the Endocrine Society endorse transgender hormone treatment but say it should not be given before puberty begins. At that point, the guidelines recommend puberty-blocking drugs until age 16, then lifelong sex-changing hormones with monitoring for potential health risks. Mental health professionals should be involved in the process, the guidelines say. The group’s members are doctors who treat hormonal conditions.

Those guidelines, along with YouTube videos by sex-changing teens and other media attention, have helped raise awareness about treatment and led more families to seek help, Spack said.

His report details a fourfold increase in patients at the Boston hospital. His Gender Management Service clinic, which opened at the hospital in 2007, averages about 19 patients each year, compared with about four per year treated for gender issues at the hospital in the late 1990s.

The report details 97 girls and boys treated between 1998 and 2010; the youngest was 4 years old. Kids that young and their families get psychological counseling and are monitored until the first signs of puberty emerge, usually around age 11 or 12. Then children are given puberty-blocking drugs, in monthly $1,000 injections or implants imbedded in the arm.

In another Pediatrics report, a Texas doctor says he’s also provided sex-changing treatment to an increasing number of children; so has a clinic at Children’s Hospital Los Angeles where the 8-year-old is a patient.

The drugs used by the clinics are approved for delaying puberty in kids who start maturing too soon. The drugs’ effects are reversible, and Spack said they’ve caused no complications in his patients. The idea is to give these children time to mature emotionally and make sure they want to proceed with a permanent sex change. Only 1 of the 97 opted out of permanent treatment, Spack said.

Kids will more easily pass as the opposite gender, and require less drastic treatment later, if drug treatment starts early, Spack said. For example, boys switching to girls will develop breasts and girls transitioning to boys will be flat-chested if puberty is blocked and sex-hormones started soon enough, Spack said.

Sex hormones, especially in high doses when used long-term, can have serious side effects, including blood clots and cancer. Spack said he uses low, safer doses but that patients should be monitored.

Gender-reassignment surgery, which may include removing or creating penises, is only done by a handful of U.S. doctors, on patients at least 18 years old, Spack said. His clinic has worked with local surgeons who’ve done breast removal surgery on girls at age 16, but that surgery can be relatively minor, or avoided, if puberty is halted in time, he said.

The mother of the Los Angeles 8-year-old says he’s eager to begin treatment.

When the child was told he could get shots to block breast development, “he was so excited,” the mother said.

He also knows he’ll eventually be taking testosterone shots for life but surgery right now is uncertain.

The child attends a public school where classmates don’t know he is biologically a girl. For that reason, his mother requested anonymity.

She said she explained about having a girl’s anatomy but he rejected that, refused to wear dresses, and has insisted on using a boy’s name since preschool.

The mother first thought it was a phase, then that her child might be a lesbian, and sought a therapist’s help to confirm her suspicion. That’s when she first heard the term “gender identity disorder” and learned it’s often not something kids outgrow.

Accepting his identity has been difficult for both parents, the woman said. Private schools refused to enroll him as a boy, and the family’s pediatrician refused to go along with their request to treat him like a boy. They found a physician who would, Dr. Jo Olson, medical director of a transgender clinic at Children’s Hospital Los Angeles.

Olson said the journal reports should help persuade more doctors to offer these kids sex-changing treatment or refer them to specialists who will.

“It would be so nice to move this out of the world of mental health, and into the medical world,” Olson said.